Hearing Loss in Elders
Michelle Colburn, AuD
Department of Communication Sciences & Disorders
Presbycusis
• Physiologic effects of aging
– Sensory Presbycusis
• Degeneration of hair cells & cochlear fibers
• Sloping, slowly progressive high-freq hearing
loss (HL)
– Neural Presbycusis
• Loss of cochlear neurons
• High-freq HL with poor word recognition abilities
– Strial (metabolic) Presbycusis
• Degeneration of the stria vascularis
• Flat HL with good speech recognition
– Mechanical Presbycusis
• Alterations to the cochlear mechanics caused by
thickening & stiffening of basilar membrane
• Gradually sloping, high-freq HL with average
speech recognition
Presbycusis
• Physiologic effects of aging
– Degenerative changes are probably a
combination of the various types
• Neurological effects of aging
– Degeneration of central auditory pathways
• Leads to poorer word recognition and poorer
comprehension of connected speech
• Central auditory involvement can occur without
a decline in hearing
• Patients with auditory processing disorders rate
themselves as more handicapped than those
without
– Changes in visual speech perception
• Further aggravated by visual problems see in
the elderly
– Change in cognitive abilities
• Memory, especially working memory
• Attention
• Speed of processing
Presbycusis
• Risk Factors for Hearing Loss
– Arteriosclerosis
• Interrupts oxygenation of the cochlea
– Diabetes
• Interrupts oxygenation of the cochlea
– Accumulated noise exposure
– Exposure to ototoxic agents
– Stress
– Genetics
Audiologic Considerations
• Pure tone thresholds
– More rapid decline after 4th decade
• Auditory processing
– Difficulty discriminating sounds that differ
in pitch, duration or intensity
– Difficulty understanding time-compressed
or filtered speech
– Difficulty understanding if there is a
competing signal
• Speech Recognition
– Beyond 60, WRS scores decline 13% per
decade in males and 6% in females
Incidence of Hearing Loss
• MarkeTrak survey (2004) estimated that
31.5 million people report a hearing
difficulty; that is around 10% of the
U.S. population
• General Guidelines:
– 66% of persons 85 years or older have
hearing loss
– 3 in 10 people between the ages of 65-84
have hearing loss;
– 1 in 6 baby boomers (ages 41-59), or 14.6%,
have a hearing problem;
– 1 in 14 Generation Xers (ages 29-40), or
7.4%, already have hearing loss;
– At least 1.4 million children (18 or younger)
have hearing problems;
– It is estimated that 3 in 1,000 infants are
born with severe to profound hearing loss.
Simulation of Hearing Loss
1000 Hz LP
“Hearing impairment is an
invisible handicap, yet its effects
upon one’s personal health,
happiness, and personal wellbeing are very real.”
Chartrand, 2005
Reactions to Hearing Loss
•Physical
•Behavioral
•Cognitive
•Emotional
•Trychin, 2001
Physical Reactions
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Muscle tension
Stomach problems
Fatigue **
Headaches
Increased blood pressure
Appetite changes
Behavioral Reactions
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Bluffing
Withdrawing
Blaming
Demanding
Dominating conversations
Emotional Reactions
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Anger
Anxiety
Depression
Embarrassment
Frustration
Guilt
Cognitive Reactions
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Can’t think straight – confused
Hard to focus
Distracting thoughts
Distrustful of others
Decreased self esteem
Can’t remember what you cannot
hear clearly in the first place
Mental Health Risks
• Becoming chronically nervous or
anxious
• Becoming chronically sad or
depressed
• Feeling angry
• Loss of group identity
• Feeling marginalized
– Socially and within the family
• Loneliness
Mental Health Risks
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Becoming distrustful of people
Withdrawing from social contact
Developing poor self-image
Feeling incompetent
Feeling unacceptable to others
Feeling loss of influence or
control
Alzheimer’s or Hearing Loss?
• Alzheimer’s Disease (AD) is difficult to Dx
– Studies suggest a 45% misdiagnosis rate
• Screening exams for AD are
administered verbally
– Assume normal hearing and central
auditory processing ability
• Hearing evaluations are not performed
in most cases
– Literature also documents other cognitive
conditions (depression, anxiety, anti-social
behaviors) that are caused by undiagnosed
and uncorrected HL
Symptom Analysis and Comparison
•Late Onset AD
–Depression, anxiety,
disorientation
–Reduced language
comprehension
–Impaired memory
(esp. short-term)
–Inappropriate
psychosocial
responses
–Loss of recognition
–Denial, defensiveness,
negativity
–Distrust, suspicion of
other’s motives
Chartrand, 2005
•Untreated HL
–Depression, anxiety,
social isolation
–Reduced speech
discrimination
–Reduced cognitive
input into memory
–Inappropriate
psychosocial
responses
–Reduced mental
scores
–Denial, defensiveness,
negativity
–Distrust, paranoia
Hearing Loss is a
Communication Disorder
The Importance of Communication
• Independence
• Stimulating thinking
• Maintaining social
networks
• Enhance well-being
• Facilitating
adaptation to change
• Participation in
activities of life
Worrall & Hickson (2003)
What is the most important activity for
maintaining quality of life?
• Spending time with family and
friends (96%)
• Religious or spiritual activities
(82%)
• Exercise and physical activity
(80%)
AARP 2003
Implications
• More than 20 million Americans
live their lives with untreated HL
– They are lonely and have trouble
communicating with loved ones
– They are isolated and feel left out of
conversations
• Untreated HL costs the US
economy $56 BILLION in lost
productivity, special education,
and medical care.
Who does it affect?
• EVERYONE
• “When someone in the family has a
hearing loss, the entire family has a
hearing problem”
– Mark Ross
• Communication is a 2-way street
– The listener and speaker both experience
problems when communication breaks
down
– The listener and speaker both contribute to
communication breakdowns
– The listener and speaker are both part of
the solution
Clues to look for
• Frequently asking for repetition
• Inappropriate responses/Pretending to
understand
• Difficulty in groups
• Puzzled expression when listening
• Strained expression around eyes
• Turning head to hear better
• Avoiding social situations
• Talks too loud/soft
• Turns up TV/Radio
• Blames others for mumbling
Common Problem Situations
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Understanding on the telephone
Conversing in a car
Hearing alarm signals
People whispering
Voices on TV
Restaurants/Family dinners
Speaking from another room
Not seeing the speaker’s face
Medical Situations
Problems for Family Members
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Remembering what to do
Deciding what they understand
TV/Radio too loud
Having to repeat – A LOT
Being the interpreter
Dealing with SO’s irritation
Lack of communication
SO’s dependence on them
Isolation from family/social
situations
Effects of HL on Health and
Quality of Life
Effects of Hearing Loss on Health
• HI individuals have more chronic
conditions
• More likely to have a Dx of depression
• More likely to seek outpatient services
• Adversely affects:
– Quality of Life
– Physical & Psychosocial Functioning
– Communication with health care providers
• Increase likelihood of unfavorable outcomes
• Patient may be underserved or inappropriately
served
Green & Pope, 2001
National Council on Aging study
• Conducted in May 1999
• Included more than 2000 Hearing
Impaired (HI) persons and their family
members or close friends
• Objectives of the study:
– Measure the effect of untreated hearing
loss on quality of life among members of
the HI;
– Compare the perceptions of the HI with
family members
– Identify the reasons that those with HI do
not seek treatment
– Assess the impact of using hearing aids on
the quality of life of users
Effects of Untreated HL on Quality of Life
•Untreated
–Sadness and
Depression
–Worry and anxiety
–Paranoia
–Less social
activity
–Emotional turmoil
and insecurity
•Increases with
severity of HL
•Treated
–Better relationships
with their families
–Better feelings about
themselves
–Improved mental
health
–Greater
independence and
security
•Family members were
even more likely to report
improvements
Despite the Positive Benefits Only 1 in 5 Use Amplification
Why only 1 in 5?
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Unaware/Denial of HL
Blame others for their problem
Financial constraints
Vanity
Misinformed
Failed attempts at HAs
– Themselves or friends
• Inappropriate expectations
So, why won’t they use hearing aids?
• Denial
– “My hearing isn’t bad enough”
– More than half of persons who had
severe HL denied needing HAs
• Consumer Concerns
– Cost
– Won’t help my problem
– They don’t work well
– I don’t trust the hearing specialists
– I’ve tried one before
So, why won’t they use hearing aids?
• Stigma
– It would make me feel old
– Don’t like the way they look
– Too embarrassed
– What will others think about me?
Beyond the Hearing Loss
• Other Sources of Communication
Difficulty
– Speaker
– Listener
– Message
– Environment
The Speaker
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Talks too fast
Talks too softly
Does not use CLEAR speech
Does not get the listener’s
attention
• Hands or objects obscure face
• Talks from behind or in another
room
• Drops voice at end of sentence
The Listener
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Inattention
Lack of motivation
Inefficient/Non-use of HA
Fatigue
Emotionally upset
Speech discrimination problems
Visual problems
The Message
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Too verbose
Too much jargon
Use of run-on sentences
Lack of repetition
Slang
Ambiguous references
The Environment
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Background noise
Several people speaking at once
Lighting
Viewing angle
Distractions
Poor acoustics
Public address system
announcements
Myths About Hearing Loss
• Talking in a loud voice will allow
you to be heard and understood
• Hearing aids restore normal
hearing
• People with nerve loss cannot
benefit from hearing aids
• “He can hear me when he wants
too”
• Lip-reading can be a substitute for
hearing
Rehabilitation
• Evaluation by a licensed audiologist and/or
otolaryngologist
• Hearing Aids
• Assistive Devices
• Cochlear Implants
• Living with Hearing Loss Classes
• Listening Training
• Lipreading training
• Coping Strategies
• Assertiveness Training
• Counseling
Hearing Aid Decisions
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One vs. Two
Size
Style
Technology level
Features
ITD Hearing Aids
• Top 3 reasons:
– Poor benefit (29.6%)
– Poor performance in background
noise (25.3%)
– Fit & Comfort (18.7%)
Kochkin, 2000
Assistive Listening Devices
• EXAMPLES:
– FM hearing aids
– Shake Awake Alarm Clocks
– Amplified telephone
– Amplified stethoscope
– TDDs & Voice Carry Over telephones
– Hearing dogs
Cochlear Implants
• Device that converts acoustical
energy to electrical pulses which
stimulate the auditory nerve
• Designed for persons who are
receiving limited benefit from
hearing aids
• People of all ages can receive an
implant (<1 yr -- ???)
How can we help?
•Use communication
strategies
•Use clear speech
•Consider sources of
communication
difficulties
•Be patient
•Repeat, then
rephrase
•Provide written
information
References
• Communication Disability in Aging:
From Prevention to Intervention
– Linda E Worrall, Louise M Hickson (2003)
• MarkeTrak VII: “Hearing Loss
Population Tops 31 Million People”
– Sergei Kochkin, 2004
• Guidelines for Providing Mental Health
Services to People Who Are Hard of
Hearing
– Samuel Trychin (2001)
• Effects of Hearing Impairment on Use
of Health Services Among the Elderly
– Carla Green & Clyde Pope
– Journal of Aging & Health, 2001
References
• The Consequences of Untreated
Hearing Loss in Older Persons
– The National Council on the Aging, 1999
• MarkeTrak V: “Why my hearing aids are
in the drawer”: The consumers’
perspective
– Sergei Kochkin, 2000
• Undiagnosed Pre-Existing Hearing
Loss in Alzheimer’s Disease Patients?
– Max Stanley Chartrand
– Healthy Hearing, 2005
– www.healthyhearing.com/library/article_co
ntent.asp?article_id=715